Review and Feature Article
Nonadherence to Asthma Treatment: Getting Unstuck

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Nonadherence is Old News

Nonadherence in patients with respiratory diseases has been well documented. More than 25 years ago, clinical asthma researchers began to realize that patient self-reports of high rates of treatment adherence, including those produced through clinical trial diary cards, were largely fictional, exaggerating adherence by more than 50%.1 Reports from studies using blood serum measures of adherence began to produce a sobering reality about the extent of the nonadherence problem, including

Interventions are Prolific But No Silver Bullet has Arrived

Recognition of the depth of the asthma nonadherence problem unleashed a flood of studies designed to improve adherence. Attempts to change patient behavior included dose simplification,9 patient education,10 motivational interviewing,11 adherence feedback,12 provider communication skill training,13 and use of mobile communication technology.14 Collectively, most interventions had a positive but modest impact on adherence. Multifaceted interventions that combined these strategies were often more

Getting Stuck

The field of adherence research has become stuck. Despite widespread awareness of the problem of nonadherence and numerous randomized controlled trials testing adherence interventions, patients with asthma have not become more adherent over time. A sample of 9 studies conducted between 1996 and 2015 and using objective measures of adherence indicate no overall change in adherence rates over 3 decades (Table I).

In addition, interventions to improve asthma treatment adherence, while prolific and

Getting Unstuck

The 10 articles included in this special issue provide new perspectives on an old problem with exploration of 4 areas of adherence research: (1) definitions and terminology, (2) research design and methods, (3) inhaler competency, and (4) patient-centered care. The articles reflect collaborations across 12 countries, with most from Europe. Six of the writing groups26, 27, 28, 29, 30, 31 have emerged from the European Respiratory Effectiveness Group (EREG) meeting in association with the 2015

What Next?

Adherence to asthma treatments is low and has not improved over the last 2 decades despite numerous attempts to create innovative behavioral interventions. The collection of reviews and reports included in this special issue deliver guidelines to help advance the adherence research field. These include recognizing that the problem of nonadherence stretches beyond the simple question of whether a patient took the correct amount of medication every day; that inadequate adherence and incorrect

References (35)

Cited by (54)

  • Effect of an Asthma Exacerbation on Medication Adherence

    2023, Journal of Allergy and Clinical Immunology: In Practice
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    For instance, a study of over 5,000 patients who were monitored for 12 months found that more than half filled the controller inhaler just once in that period and that patients filled enough medication to cover only 22.2% of the days during that time.4 Many factors have been found to influence adherence, including the cost of medication, patient perceptions of disease, fear of side effects, education, and socioeconomic status (SES) as well as medication availability and affordability.3 Studies looking at interventions to improve adherence have focused on implementation and less often on the persistence of adherence over time.5

  • Teleallergy: Where Have We Been and Where Are We Going?

    2023, Journal of Allergy and Clinical Immunology: In Practice
  • Social robots and therapeutic adherence: A new challenge in pediatric asthma?

    2021, Paediatric Respiratory Reviews
    Citation Excerpt :

    Lastly, the so-called “unintentional non-adherence” is due to the child’s disproportionate responsibility in taking his medications [10]. Given the increasing awareness about non-adherence in asthma, several interventions, including patient/caregiver education and innovative electronic health (e-Health) tools, have been tested in children with different levels of asthma severity, showing only a modest impact on adherence [11–14]. Among the innovative tools for improving treatment adherence, e-Health technological solutions have been recently proposed as valuable instruments for children and adolescents with asthma and their families.

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Conflicts of interest: B. G. Bender is a board member for GlaxoSmithKline and Teva, has consultancy arrangements with GlaxoSmithKline, and has received speaker fees from Merck and Sandoz.

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